Remote Utilization Review RN – Care Coordination

CommonSpirit Health; Longmont (CO); Remote; USD 90,000 - 120,000; Full time

Job summary

Longmont United Hospital in Colorado is seeking an Utilization Review RN to review medical records and confirm admission status and continued hospitalization using established criteria and critical thinking. You will collaborate with Concurrent Denial RNs, Patient Access, and Care Coordinators to verify payer sources and obtain inpatient authorization.

You will perform admission, concurrent and post-discharge reviews, ensure compliance with UR principles and external agencies, identify

Qualifications

• Must have nursing degree and active RN license.
• Experience with utilization review or case management is preferred.
• Knowledge of CMS standards and payer environments.

Responsibilities

• Conduct admission, concurrent and post-discharge reviews to ensure hospitalization is warranted.
• Review records for accurate patient status orders and address deficiencies with providers.
• Communicate with physicians, payers, and Care Coordinators regarding outcomes and timelines.
• Collaborate with facility RN Care Coordinators to ensure progression of care.
• Engage second level physician reviewer to support appropriate status.
• Identify root causes of denials and implement prevention strategies per UR guidelines.

Skills

Critical thinking

Communication

Collaboration

Time management

Clinical guidelines knowledge

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing (BSN)

Masters degree in Case Management or Nursing

RN License; current state licensure or NLC participation

Job description

Longmont United Hospital in Colorado is seeking an Utilization Review RN to review medical records and confirm admission status and continued hospitalization using established criteria and critical thinking. You will collaborate with Concurrent Denial RNs, Patient Access, and Care Coordinators to verify payer sources and obtain inpatient authorization.

You will perform admission, concurrent and post-discharge reviews, ensure compliance with UR principles and external agencies, identify